Meningitis Outbreak: Death Toll Hits 20

by David Pittman, Washington Correspondent; Michael Smith North American Correspondent, MedPage Today

The 20th death and 18 new cases top the CDC's Thursday update on the fungal meningitis outbreak linked to a contaminated steroid from the New England Compounding Center (NECC).

Also, New York state reported its first confirmed case in the outbreak, and an additional case of peripheral joint infection was confirmed. The nationwide total has now grown to 257 cases in 16 states -- mostly meningitis cases, but also three peripheral joint infections.

The new death came from Michigan, which also reported additional cases along with Indiana, New Hampshire, New Jersey, Ohio, and Tennessee.

The CDC also confirmed that the fungus Exserohilum rostratum is the culprit behind the outbreak.

The FDA obtained the fungus from unopened vials of one lot of the suspect steroid, methylprednisolone acetate, that the agency took from the compounding center, which is in Framingham, Mass. CDC experts grew the fungus and confirmed it was Exserohilum, agency spokesman Curtis Allen told MedPage Today.

"We were all thinking that, but this helps firm it up," said Tom Chiller, MD, deputy director of the agency's mycotic diseases branch.

Chiller said at the annual IDWeek meeting in San Diego that other fungi have also been found in the vials, but they are unlikely to be involved, since they do not grow at 37 degrees Celsius – human body temperature.

"If they don't grow at 37 degrees, they don't grow in the body," he told MedPage Today.

Chiller said the identification won't change the agency's clinical recommendations for treatment, because the CDC and FDA had strongly suspected Exserohilum was behind the outbreak.

The fungus has been isolated from 45 of the 47 patients with lab-confirmed fungal meningitis, Chiller said.

The outbreak has been linked to three lots of the steroid, shipped to pain clinics in 23 states. The CDC said Exserohilum was confirmed in just one of the three implicated lots -- #08102012 – and laboratory testing continues on the other two.

The CDC and state health departments suspect roughly 14,000 patients have received methylprednisolone injections from the three tainted lots and about 97% of patients have been contacted for follow-up.

Chiller told MedPage Today that it remains unclear why some people come down with disease while others do not.

"We're all asking that question and I think we just don't know yet," he said.

Among other things, the question is challenging because officials don't know – and may never know -- such basic things as whether all vials were contaminated, whether some vials had more fungus than others, and whether multiple injections increased the risk.

Meanwhile, some patients who have received injections of NECC products -- some who have contracted disease and some who have not -- have already filed lawsuits against the company, according to news reports. Cases reportedly have been filed in Virginia, Florida, and New Jersey -- three states that have a combined 51 confirmed cases as of Thursday.

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